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N.C. State Health Plan targets smokers and obese

Posted February 19, 2009
Updated March 9, 2009

— State employees would have to stop smoking or lose weight if they want to receive more generous health benefits under a proposal presented to legislators Thursday.

The financial motivation for workers, retirees and their dependents to improve their health are contained in recommendations from North Carolina State Health Plan administrator Jack Walker to shore up the plan's finances. The plan last year discontinued its wellness program that gave merchandise to people who changed health habits.

"Money incentives in smoking work," Walker told told the Joint Committee on Employee Hospital and Medical Benefits, comprised of lawmakers that oversee the health plan. "Offering prizes is ineffective."

Cigarette Smoking Generic State health plan changes proposed

The proposal, included in a drafted bill that will soon be introduced in the Legislature, also would give an immediate $250 million cash injection to the plan so it can pay its claims this spring.

"Somewhere in the latter part of March, we will have insufficient funds to pay hospitals and physicians," Walker said. "We are concerned for our members and we are concerned for the providers."

The measure also would raise premiums for workers or retirees who insure their spouses or dependents by 7.3 percent annually for the next two years. For example, an employee or retiree who also enrolls their family would see their premium rise from about $489 today to $563 by July 2010.

The number of coverage tiers would drop from three to two and most deductibles and copays for doctor visits and prescription drugs would increase.

The changes would mean the Legislature would have to inject an additional $349 million in cash into the two-year budget beginning July 1. Two weeks ago, legislators were told they might have to find $1 billion over the next two years to cover claims without changes to the plan, which cover about 667,000 employees, retirees and dependents.

But the proposal's bottom line would mean higher premiums and eroded benefits.

"It ain't no good news," said Senate Majority Leader Tony Rand, D-Cumberland, a committee co-chairman. Rand said a bill needs to be passed by April 1.

The bill's biggest adjustment to the plan would directly link coverage levels to a person's weight or smoking habits.

Walker said the proposal reflects that the 70,000 smokers in the plan generate $2,000 in higher medical expenses than nonsmokers. Patients that are among the most obese in the plan have nearly $2,400 more in expenses than other people in the group.

"We have a rather large group, both literally and figuratively," Walker said. "Obesity is a growing issue."

As of July 2010, nonsmokers or people in a quit-smoking program would be able to receive coverage in the more generous of the two coverage tiers. The plan would set up a system to determine whether an enrollee doesn't smoke and beef up smoking cessation initiatives.

If one person in a covered family smokes, then the entire family wouldn't qualify and would receive the coverage with more out-of-pocket costs.

Smokers should pay their extra share of costs, said Ken Smith, a Department of Transportation worker who has smoked for about 10 years.

"I probably think that's fair," said Smith, 48, of Garner, holding a cigarette while walking on a downtown Raleigh street. "It just makes sense to me."

Wendell Powell, who works for the state as a detention officer, can understand the smoking issues, but not the obesity part of the proposal. He said the changes would only add to his stress of providing for his family in hard times.

“You have to eat quick,” Powell said. “Because I work two jobs…sometimes I can’t eat a healthy meal.”

Enrollees with a body mass index – a weight-height ratio that determines whether a person is considered overweight – below 40 can stay in the more generous plan as of July 2011 and below 35 as of July 2012.

For example, a person who is 6 feet tall and 294 pounds has a body mass index of 40. A person 6 feet tall and 258 pounds has an index of 35, according to a table presented by the health plan.

The 55,000-member State Employees Association of North Carolina supports the changes to promote healthy plan members, said Chuck Stone, a lobbyist involved in a health care advocacy group linked to the association.

"There should be an incentive for people to engage in healthy and good health practices," Stone said.

Stone said the proposal, which must be approved by the Legislature, still doesn't do enough to encourage young or healthy spouses of employees or family members to join the plan. Walker said he's working on a proposal to reduce premiums for workers and their spouses who are in their 20s and 30s.


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  • simplecommonsense Mar 19, 2009

    The other part of the problem is that BMI is a flawed measure of weight/obesity. According to the BMI scale, an extremely muscular person who is 6' and close to 300lbs is considered obese or morbidly obese, because the BMI scale does not accommodate muscle mass at all. A lot of athletes (think wrestlers and football players) and former athletes will be considered obese by this scale. If the BMI scale accommodated for muscle mass percentage, a lot of people currently considered obese would not be categorized as such, and a lot of people who were morbidly obese would only be categorized as obese.

    Since the plan also provides no assistance or roadmap for people who are obese and want to reduce their weight, it amounts to nothing more than a tax. If you're going to tax people for their weight, tax alcoholics for their drinking, tax women for having babies, etc. Drinking and having children account for just as much if not more in health care expenditures as smokers and the obese.

  • simplecommonsense Mar 19, 2009

    Accountability is all well and good, but there are some problems with the logic used in the changes to the health plan.

    Smoking is always 100% of the time a choice, and I, as a former smoker agree that smokers need to be held accountable. The problem is that unless there is some sort of mandatory test that determined whether or not someone is a smoker, smokers will not be held accountable, because they can just say that they're not a smoker or have quit. If doctors dig too deep or make assumptions about someone's smoking habits, the lawsuits will fly. Bottom line there is no good way to determine if someone smokes.

    Not everyone who is considered Obese according to BMI can help it. Weight gain can be secondary to other problems that are unrelated including depression, insomnia, and various diseases. Are those people to be assessed a tax because they gained weight as a secondary symptom of another problem? That's ridiculous!

  • terrie Feb 23, 2009

    Unfortunately, the State Health plan does not pay for weight control or exercise programs. This discriminates against all who are predispositioned to gain weight. Shall we know increase premiums for those who become pregnant. How about those with a family history of heart disease or cancer? As usual, the legislature wants to take the easy way out. There are people in this state who are wealthy and pay far too little in taxes. If the state wants healthier workers, try reducing the stress by straightening out the Beacon pay system. It's shocking that SEANC and NCAE both support this window dressing measure. Alcohol causes health problems. Shall we now require prohibition. Of course not because the liquor lobby is more powerful than the state employess lobby.

  • lbl3373 Feb 23, 2009

    oh lets cry discrimination now... last time i checked fat people and smokers are not included within any kind of discrimination statutes

  • restless native Feb 23, 2009

    8 out of 10 people go home and guzzle booze every night. Please include them in this discrimination.

  • commonsensenc Feb 23, 2009

    Smokers will lie and the only ones paying extra will be the obese who can not hide it, can you say "Discrimination".

  • jse830fcnawa030klgmvnnaw+ Feb 20, 2009

    I disagree with this proposal, and I am not a smoker or obese.

  • MizzZeta Feb 20, 2009

    I hear many more people doing what you suggest, james.

  • gotsomesense Feb 20, 2009

    Good point james27613. I have already paid privately for my son's insurance once. Be careful to look at more than premiums though. You have to compare deductibles, co-pays, max out-of-pockets etc. Also don't forget to factor in that the state premium is pre-tax and private insurance is post-tax. The income tax you have to pay on the money that would have been your premium has to be considered too.

  • gotsomesense Feb 20, 2009


    Your premium should be lower if you don't smoke and aren't obese.

    And I'm sorry, one man didn't ruin the State Health Plan. No one wants to insure state workers because 1) we're statistically unhealthy and 2) we make up an aging workforce. The state is self-insured now because no one wanted us on their books. BCBS DOES NOT insure state workers, they are only paid to administer the paperwork of the plan. The state is self-insured!!! This has nothing to do with greed on any insurance company's part. Besides, any company, insurance or otherwise, is in business to make a profit for their shareholders. They are not in the business to be nannies for people, whether their health problems are their own fault or not. That is called capitalism and right or wrong it is what our economy is based on. Everyone wants to blame everyone, but if you're not doing your part to keep costs low by making wise choices then you are not helping the situation for yourself or anyone else.